Rockland County Volunteer Enrollment Form (Confidential)

Thank you for considering dedicating your free time to help your community in emergency situations. Please fill out and submit the following form and we will reach out to you as soon as possible.

Full Name: (required)

Date of Birth:

Gender:MaleFemale

Address

City

State

Zip Code

Your Email

Home Phone

Alternate phone:

Occupation:

Employment status:

Level of education:

How did you find out about volunteering?

Have you seen or were you influenced by our promotional marketing materials? (check all that apply)Road SignNewspaper Ads/ArticlesWebsiteTV/Radio AdsPostersLiteratureIn-person PresentationNone of the above